Laboratory Medicine Updates - February 26, 2002

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SystemMedical Laboratories“Quality You Expect, Service You
Deserve”

LABORATORY MEDICINE
UPDATE

February 26, 2002

The UVA Cytology Laboratory is converting to the
2001 version of the Bethesda System (TBS) for reporting
cervical/vaginal interpretations and is providing this overview of the
changes in the system to all individuals submitting Pap specimens to
the laboratory. The expected conversion date is the evening of February
27, 2002. All Cytopathology Final Reports for Pap tests issued
AFTER that date will use the new terminology and the
new reporting format. An example of the new format
appears at the end of this document.

CONVERSION TO BETHESDA 2001

In 1988 the Division of Cancer Prevention and
Control at the National Cancer Institute convened a workshop of experts
and consultants to review the then existing terminology for reporting
of cervical/vaginal interpretations of gynecologic Pap smears. The
result of this workshop was the Bethesda System for the uniform
reporting of cervical and vaginal specimen interpretations. Some minor
revisions and clarifications to the system were instituted after a
second workshop in 1993.

In May 2001, the 2001 Bethesda Conference assembled a large body of
pathologists, cytotechnologists, clinicians, nurses, and other
interested parties worldwide to review the application of TBS over the
previous ten years and to make suggestions for improvements in the
system. After much discussion and debate, significant revisions were
made in the reporting terminology in an attempt to facilitate
appropriate patient management.

SPECIMEN TYPE:

The patient report should state the type of
specimen submitted to the laboratory (conventional Pap smear or a
liquid-based preparation [ThinPrep or Autocyte] or other).

STATEMENT OF ADEQUACY:

Specimens will be designated either satisfactory or unsatisfactory
for interpretation. The “limited by” designation has been
removed from TBS. However, quality indicators that may hamper
or limit the interpretation of “satisfactory” specimens will be listed
in the statement of adequacy (e.g., lack of endocervical/transformation
zone component, partially obscuring blood or inflammation, etc.).

For specimens determined to be unsatisfactory for evaluation, the
statement of adequacy becomes the final interpretation. The reason(s)
for the unsatisfactory result is always stated in the report.

INTERPRETATIONS/RESULTS:

One of the most significant changes with TBS 2001 is in the
reporting of normal or benign findings. The previous categories of
“Within Normal Limits” and “Benign Cellular Changes” have been combined
under the single heading of NEGATIVE FOR INTRAEPITHELIAL LESION
OR MALIGNANCY. The presence of infectious organisms (e.g.,
Trichomonas, Herpes, Candida, etc.) will be indicated, as appropriate,
with this interpretation. Other non-neoplastic findings (benign
cellular changes) are considered optional and, when reported, will be
listed under the heading of “Additional Findings” in the final
report.

The presence of endometrial cells outside of
menses in women 40 years of age and older will be reported separately
from the “Negative” category. This interpretation will also state if
the specimen is “negative for squamous intraepithelial lesion.”

The equivocal interpretation categories (ASCUS and AGUS) have also
undergone revision. The “favor benign process” designation has
been eliminated for both the ASCUS and AGUS groups. The label
“atypical cells” should be limited to only those cases of uncertain
neoplastic potential as listed below.

Atypical squamous cells

· NOS

· cannot exclude a high
grade intraepithelial lesion

Atypical glandular cells

· atypical endocervical
cells (NOS or specify in comments)

· atypical endometrial
cells (NOS or specify in comments)

· atypical glandular cells
(NOS or specify in comments)

· atypical endocervical
cells, favor neoplastic

· atypical glandular
cells, favor neoplastic

The reporting of clearly defined epithelial abnormalities
(intraepithelial lesions and malignancies) remains unchanged in TBS
2001. Endocervical adenocarcinoma in situ is reported as a
distinct entity (as it has always been reported at UVA).
Whenever possible, an interpretation of adenocarcinoma should indicate
the site of origin (endocervical, endometrial, extrauterine, NOS).

EDUCATIONAL NOTES AND SUGGESTIONS:

Educational notes and suggestions are optional. Suggestions should
be concise and consistent with clinical follow-up guidelines published
by professional organizations. http://www.asccp.org

ANCILLARY TESTING:

The results of any ancillary testing performed on the specimen will
be given either in the final report or as an addendum to that report.
The results will provide a brief description of the test method and the
test outcome so that clinicians can easily understand them.

REFERENCE:

The full Table of the final Bethesda 2001 Terminology is available
at the Web site

http://bethesda2001.cancer.gov.
Select the “Final 2001 terminology” button from the left menu. A PDF
version is available for downloading the table. The manuscript of
explanatory text for Bethesda 2001 is in progress and should be
published this year.

UVA FINAL REPORT:

The Cytology Laboratory is reformatting the final reports for Pap
specimens to accommodate 2001TBS. All cytologic findings (morphologic
interpretation, statement of adequacy, additional findings,
suggestions) will be reported under the single header “Final Cytologic
Interpretation” with the morphologic interpretation given in bold
print. This will give the clinician all of the necessary results
information in a single field. The note field will be reserved for any
detailed descriptions or observations that the pathologist may choose
to make.

If you have any questions or need additional information, please
contact the Cytology Laboratory at (434) 924-2779 or 2770.